Eurosurveillance remains in the updated list of the Directory of Open Access Journals (DOAJ). It was first added to the DOAJ on 9 September 2004. Eurosurveillance is also listed in the Securing a Hybrid Environment for Research Preservation and Access / Rights MEtadata for Open archiving (SHERPA/RoMEO) [2], a database which uses a colour‐coding scheme to classify publishers according to their self‐archiving policy and to show the copyright and open access self-archiving policies of academic journals. Eurosurveillance is listed there as a ‘green’ journal, which means that authors can archive pre-print (i.e. pre-refereeing), post-print (i.e. final draft post-refereeing) and archive the publisher's version/PDF.

Three confirmed and three suspected cases of trichinellosis have been reported in France with onset of symptoms in March 2009, linked to consumption of smoked warthog ham in Senegal.

Case detection and description

In early May 2009, the French National Reference Centre (NRC) for Trichinella was informed about three unrelated patients returning from Senegal who had high titres of specific anti-Trichinella antibodies (ELISA confirmed by western blot, LDBio Diagnostics, Lyon, France). Subsequently, the NRC identified a cluster of at least three confirmed cases according to the case definition criteria for trichinellosis defined in the guidelines of the Food and Agriculture Organization of the United Nations (FAO), World Health Organization (WHO) and World Organization for Animal Health (OIE) [1]. The patients were interviewed with a standard questionnaire available at the NRC web page [2]. It was established that the three patients, who lived in different regions of France, became infected after consumption of smoked warthog (Phacochoerus africanus) ham around mid-February 2009, in the same hotel in Saint–Louis (Ndar) in Senegal. The typical clinical symptoms (fever, facial and limbs oedema, myalgia) and biological signs (high eosinophilia ranging from 1 to 3.3 G/l, increased levels of muscular enzymes) appeared from early March to early April. No cardiac or neurological complications were observed. Only one patient was hospitalised, in France, for two weeks. All three patients were treated with albendazole (7.5 mg/kg twice a day for 15 days) and corticosteroids.

Outbreak investigation

Trichinellosis was suspected in three additional persons. Two of the suspected cases were the wife and the husband of two of the confirmed cases; they felt sick and tired but without typical signs. The third suspected case was a colleague of one confirmed case who presented suggestive signs (fever and diarrhoea) while still in Senegal where he lives. All three stayed in the same hotel and shared meals with the confirmed cases. Two of the suspected cases tested negative for anti-Trichinella antibodies but these tests were performed early after the suspected date of infection and no subsequent assays were performed. The three suspected cases were also treated with albendazole as they shared meals with the confirmed cases.

The hotel, in which the three confirmed and the three suspected cases stayed and were infected, hosts guests from different European countries. According to the hotel director, no other cases of trichinellosis were reported amongst the guests or staff and their families although they had also consumed warthog ham. He stated that the warthog meat is usually deep-frozen for several weeks before being processed as ham. The incriminated warthog ham was not available for parasitological examination. So far, no similar cases related to these index cases have been reported, although French and European networks of parasitologists were alerted by email. The Senegalese veterinary services were also informed about this outbreak.

Discussion

Human trichinellosis was first reported in Senegal in the 1960s, when an outbreak involving nine French expatriates occurred after consumption of warthog meat coming from the Senegal delta region (Boundoum) [3]. Subsequent veterinary studies reported a 4% prevalence of Trichinella infection in 450 Senegalese warthogs [4]. Pozio et al. [5] identified isolates from carnivore mammals of neighbouring Guinea as belonging to the species Trichinellabritovi but could not find Trichinella in any of the 10 warthogs examined. T. britovi could also be present in Senegal and experiments have shown that this species of Trichinella is partially resistant to freezing [6]. Moreover, there is a lack of reliability and precision of the temperature in non industrial freezers. Outbreaks of human trichinellosis related to Suidae meat are not very frequent in Africa, although small outbreaks related to wild boar (Sus scrofa) have been described in French expatriates living in Algeria [7], to warthog (Phacochoerus sp.) in Ethiopia and Tanzania and to bush pigs (Potamochoerus sp.) in Kenya [8]. The French NRC also documented sporadic cases from Kenya (two infected persons) in 1995 and from Cameroon in 1999 (one infected person) [9]. In Africa, meat is usually consumed well done and pork is not consumed by the Muslims, which explains the fact that trichinellosis has been documented mostly in Europeans. Travel in endemic regions is a classical driver for acquiring trichinellosis and travellers should be informed of the risks of eating raw or rare meat products, and particularly game meat such as warthog in Africa [10].

Dupouy-Camet J, Murrell KD, editors. FAO/WHO/OIE Guidelines for the surveillance, management, prevention and control of trichinellosis. Food and Agriculture Organization of the United Nations (FAO), World Health Organization (WHO), World Organisation for Animal Health (OIE): Paris; 2007. Available from: ftp://ftp.fao.org/docrep/fao/011/a0227e/a0227e.pdf

Disclaimer: The opinions expressed by authors contributing to Eurosurveillance do not necessarily reflect the opinions of the European Centre for Disease Prevention and Control (ECDC) or the editorial team or the institutions with which the authors are affiliated. Neither ECDC nor any person acting on behalf of ECDC is responsible for the use that might be made of the information in this journal. The information provided on the Eurosurveillance site is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her physician. Our website does not host any form of commercial advertisement. Except where otherwise stated, all manuscripts published after 1 January 2016 will be published under the Creative Commons Attribution (CC BY) licence. You are free to share and adapt the material, but you must give appropriate credit, provide a link to the licence, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.